title: Intralesional cyclosporine in the treatment of psoriasis. A clinical, immunologic, and pharmacokinetic study.
abstract: In a double-blind, vehicle-controlled study, all of six psoriatic plaques treated with intralesional cyclosporine administered three times weekly for 4 weeks showed complete clearing or incomplete but significant clearing in comparison with vehicle-treated plaques (p less than 0.01). Epidermal thickness decreased from 0.42 +/- 0.07 to 0.27 +/- 0.08 mm at 4 weeks (p less than 0.03). Biopsy specimens obtained on day 5, before any clinical improvement, revealed a significant reduction of epidermal DR+CD1- antigen-presenting cells, epidermal and dermal monocytes, and keratinocyte intercellular adhesion molecule-1 expression. By day 5 the stratum corneum reverted to normal in the plaques receiving cyclosporine. Pain at the injection site was the major side effect. Steady-state blood cyclosporine levels ranged from 20 to 30 ng/ml during the first 12 hours after injection and became undetectable at 48 hours. These data suggest that cyclosporine improves the skin of patients with psoriasis by a local mechanism of action.
authors.affiliation: Department of Dermatology, University of Michigan Medical Center, Ann Arbor 48109-0314.
authors.forename: V C
authors.initials: VC
authors.lastname: Ho
authors.forename: C E
authors.initials: CE
authors.lastname: Griffiths
authors.forename: C N
authors.initials: CN
authors.lastname: Ellis
authors.forename: A K
authors.initials: AK
authors.lastname: Gupta
authors.forename: C C
authors.initials: CC
authors.lastname: McCuaig
authors.forename: B J
authors.initials: BJ
authors.lastname: Nickoloff
authors.forename: K D
authors.initials: KD
authors.lastname: Cooper
authors.forename: T A
authors.initials: TA
authors.lastname: Hamilton
authors.forename: J J
authors.initials: JJ
authors.lastname: Voorhees
mesh_terms: D000328:Adult; D000938:Antigen-Presenting Cells / Q000473:pathology; D015815:Cell Adhesion Molecules / Q000032:analysis; D003524:Cyclosporins / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D004311:Double-Blind Method; D004817:Epidermis / Q000473:pathology; D006801:Humans; D015552:Injections, Intralesional; D007801:Langerhans Cells / Q000473:pathology; D014677:Pharmaceutical Vehicles; D010919:Placebos; D011565:Psoriasis / Q000188:drug therapy* / Q000276:immunology / Q000473:pathology; D011897:Random Allocation; D013601:T-Lymphocytes / Q000473:pathology; D013997:Time Factors
chemical_list: D015815:Cell Adhesion Molecules; D003524:Cyclosporins; D014677:Pharmaceutical Vehicles; D010919:Placebos